Identification and analysis of 261 strains of non-tuberculous mycobacteria in Fujian Province

doi:10.3969/j.issn.1000-6621.2021.06.012

Abstract

Abstract:

Objective To identify non-tuberculous mycobacteria (NTM) strains and analyze their distributions in Fujian Province, so as to provide scientific evidence for clinical diagnosis, treatment and epidemiological research of NTM disease in Fujian Province. Methods A total of 3355 strains of mycobacterium were collected from nine drug-resistant tuberculosis surveillance sites and nine tuberculosis laboratories of municipal level Center for Disease Control and Prevention in Fujian Province from June 2016 to December 2019. A total of 261 NTM strains were identified by PNB growth test, and then tested with the GenoType Mycobacterium CM kit. DNA sequencing or MeltPro Myco kit were used for further identification of strains that could not be identified by the above method. Results Among 261 strains, 213 (81.61%) were NTM and the separation rate of NTM was 6.35% (213/3355). Among them, the top three species of all NTM were M.intracellulare (65.73%,140/213), M.abscessus (17.37%,37/213) and M.kansasii (4.22%,9/213). In this study, six rare species of mycobacteria were found-M.arupense, M.peregrinum, M.phocaicum, M.sinense, M.vanbaalenii and M.dioxanotrophicus. In addition, 9 mixed infection strains were identified, including 8 mixed infections of MTBC and M.intracellulare, and 1 mixed infection of MTBC and M.avium. Conclusion Three identification methods of NTM species were combined to reveal that the three most prevalent NTM species in Fujian were M.intracellulare, M.abscessus and M.kansasii, and 6 rare NTM and 9 mixed infection strains have been found.

Key words: Mycobacteria,atypical, Bacterial typing techniques, Polymerase chain reaction, Epidemiologic studies

LIN Jian, ZHAO Yong, DAI Zhi-song, WEI Shu-zhen, LIN Shu-fang. Identification and analysis of 261 strains of non-tuberculous mycobacteria in Fujian Province[J]. Chinese Journal of Antituberculosis, 2021, 43(6): 590-595. doi: 10.3969/j.issn.1000-6621.2021.06.012

Figures/Tables 2

References 27

[1]	中华医学会结核病学分会, 《中华结核和呼吸杂志》编辑委员会. 非结核分枝杆菌病诊断与治疗专家共识. 中华结核和呼吸杂志, 2012,35(8):572-580. doi: 10.3760/cma.j.issn.1001-0939.2012.08.006. doi: 10.3760/cma.j.issn.1001-0939.2012.08.006
[2]	中华医学会结核病学分会. 非结核分支杆菌病诊断与处理指南. 中华结核和呼吸杂志, 2000,23(11):650-653. doi: 10.3760/j:issn:1001-0939.2000.11.003. doi: 10.3760/j:issn:1001-0939.2000.11.003
[3]	Forbes BA, Hall GS, Miller MB, et al. Practice Guidelines for Clinical Microbiology Laboratories: Mycobacteria. Clin Microbiol Rev, 2018,31(2):e00038-17. doi: 10.1128/CMR.00038-17. doi: 10.1128/CMR.00038-17
[4]	Falkinham JO 3rd. Environmental sources of nontuberculous mycobacteria. Clin Chest Med, 2015,36(1):35-41. doi: 10.1016/j.ccm.2014.10.003. doi: 10.1016/j.ccm.2014.10.003 URL
[5]	杨栗坤, 曹彦, 曹艳龙, 等. 结核病专科非结核分枝杆菌肺病菌种分布及病例特点研究. 中国人兽共患病学报, 2018,34(12):1137-1141. doi: 10.3969/j.issn.1002-2694.2018.00.198. doi: 10.3969/j.issn.1002-2694.2018.00.198
[6]	全国第五次结核病流行病学抽样调查技术指导组, 全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告. 中国防痨杂志, 2012,34(8):485-508.
[7]	郑惠文, 赵雁林. 大力加强非结核分枝杆菌病的实验室诊断研究. 中国防痨杂志, 2016,38(9):697-700. doi: 10.3969/j.issn.1000-6621.2016.09.001. doi: 10.3969/j.issn.1000-6621.2016.09.001
[8]	马玙. 关注非结核分枝杆菌肺病的诊断与治疗. 中华结核和呼吸杂志, 2011,34(8):566-568. doi: 10.3760/cma.j.issn.1001-0939.2011.08.005. doi: 10.3760/cma.j.issn.1001-0939.2011.08.005
[9]	张智健, 逄宇, 赵雁林, 等. 脓肿分枝杆菌复合群的研究进展. 中国防痨杂志, 2015,37(6):650-654. doi: 10.3969/j.issn.1000-6621.2015.06.017. doi: 10.3969/j.issn.1000-6621.2015.06.017
[10]	赵雁林, 中国防痨协会基础委员会. 结核病实验室诊断技术培训教程. 北京: 人民卫生出版社, 2014: 55-57.
[11]	Russo C, Tortoli E, Menichella D. Evaluation of the new GenoType Mycobacterium assay for identification of mycobacterial species. J Clin Microbiol, 2006,44(2):334-339. doi: 10.1128/JCM.44.2.334-339.2006. doi: 10.1128/JCM.44.2.334-339.2006 URL
[12]	Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med, 2007,175(4):367-416. doi: 10.1164/rccm.200604-571ST. doi: 10.1164/rccm.200604-571ST URL
[13]	中华医学会结核病学分会. 非结核分枝杆菌病诊断与治疗指南(2020年版). 中华结核和呼吸杂志, 2020,43(11):918-946. doi: 10.3760/cma.j.cn112147-20200508-00570. doi: 10.3760/cma.j.cn112147-20200508-00570
[14]	楼海, 孙勤, 顾瑾, 等. 常见非结核分枝杆菌肺病的临床特征及药物敏感试验结果分析. 中华结核和呼吸杂志, 2019,42(12):901-906. doi: 10.3760/cma.j.issn.1001-0939.2019.12.005. doi: 10.3760/cma.j.issn.1001-0939.2019.12.005
[15]	Xu Y, Liang B, Du C, et al. Rapid Identification of Clinically Relevant Mycobacterium Species by Multicolor Melting Curve Analysis. J Clin Microbiol, 2019,57(1):e01096-18. doi: 10.1128/JCM.01096-18. doi: 10.1128/JCM.01096-18
[16]	Zhou L, Xu D, Liu H, et al. Trends in the Prevalence and Antibiotic Resistance of Non-tuberculous Mycobacteria in Mainland China, 2000-2019: Systematic Review and Meta-Analysis. Front Public Health, 2020,8:295. doi: 10.3389/fpubh.2020.00295. doi: 10.3389/fpubh.2020.00295 pmid: 32850570
[17]	Zhang H, Luo M, Zhang K, et al. Species identification and antimicrobial susceptibility testing of non-tuberculous mycobacteria isolated in Chongqing, Southwest China. Epidemiol Infect, 2020,149:e7. doi: 10.1017/S0950268820003088. doi: 10.1017/S0950268820003088 URL
[18]	Tan Y, Su B, Shu W, et al. Epidemiology of pulmonary disease due to nontuberculous mycobacteria in Southern China, 2013—2016. BMC Pulm Med, 2018,18(1):168. doi: 10.1186/s12890-018-0728-z. doi: 10.1186/s12890-018-0728-z URL
[19]	潘建华, 石国民, 彭雪峰, 等. 长沙地区2012—2017年非结核分枝杆菌流行状况分析. 国际检验医学杂志, 2018,39(20):2496-2498.
[20]	张洁, 苏建荣, 丁北川, 等. 北京地区非结核分枝杆菌菌种分布及耐药性研究. 中华结核和呼吸杂志, 2017,40(3):210-214. doi: 10.3760/cma.j.issn.1001-0939.2017.03.013. doi: 10.3760/cma.j.issn.1001-0939.2017.03.013
[21]	Pang Y, Tan Y, Chen J, et al. Diversity of nontuberculous mycobacteria in eastern and southern China: a cross-sectional study. Eur Respir J, 2017,49(3):1601429. doi: 10.1183/13993003.01429-2016. doi: 10.1183/13993003.01429-2016 URL
[22]	黄明翔, 万康林, 陈力舟, 等. 福建省临床分离非结核分枝杆菌菌种分布研究. 中国人兽共患病学报, 2014,30(12):1227-1230. doi: 10.3969/cjz.j.issn.1002-2694.2014.12.012. doi: 10.3969/cjz.j.issn.1002-2694.2014.12.012
[23]	王建, 胡立珍, 张国翠, 等. PNB/TCH生长试验和DNA微阵列基因芯片鉴定非结核分枝杆菌的价值比较. 医学信息, 2019,32(20):178-179. doi: 10.3969/j.issn.1006-1959.2019.20.054. doi: 10.3969/j.issn.1006-1959.2019.20.054
[24]	蔡林, 陈雪, 赵亭, 等. 分枝杆菌在北京水源环境中的分布: M.arupense国内首次报告. 临床皮肤科杂志, 2008,37(1):13-16. doi: 10.3969/j.issn.1000-4963.2008.01.005. doi: 10.3969/j.issn.1000-4963.2008.01.005
[25]	Neonakis IK, Gitti Z, Kontos F, et al. Mycobacterium arupense pulmonary infection: antibiotic resistance and restriction fragment length polymorphism analysis. Indian J Med Microbiol, 2010,28(2):173-176. doi: 10.4103/0255-0857.62502. doi: 10.4103/0255-0857.62502 pmid: 20404471
[26]	Omar SV, Allam M, Joseph L, et al. Draft Genome Sequence of Mycobacterium peregrinum Isolated from an HIV-Positive Patient in South Africa. Genome Announc, 2017,5(31):e00759-17. doi: 10.1128/genomeA.00759-17. doi: 10.1128/genomeA.00759-17
[27]	Hamada S, Okamoto N, Tsukino M. Diffuse Pulmonary Uptake of Gallium-67 Induced by Pulmonary Mycobacterium mucogenicum and Mycobacterium phocaicum Infection. Arch Bronconeumol, 2017,54(3):161-163. doi: 10.1016/j.arbres.2017.07.013. doi: 10.1016/j.arbres.2017.07.013 URL

分枝杆菌菌种	数量(株)	构成比(%)
胞内分枝杆菌	132	50.57
脓肿分枝杆菌	37	14.18
堪萨斯分枝杆菌	9	3.45
偶然分枝杆菌	8	3.06
鸟分枝杆菌	4	1.53
戈登分枝杆菌	3	1.15
龟分枝杆菌	3	1.15
瘰疬分枝杆菌	2	0.77
混合感染	9	3.45
分枝杆菌属	6	2.30
不含分枝杆菌	18	6.90
MTBC	21	8.04
阴性	9	3.45
总计	261	100.00

分枝杆菌菌种	数量(株)	构成比(%)
胞内分枝杆菌	140	65.73
脓肿分枝杆菌	37	17.37
堪萨斯分枝杆菌	9	4.22
偶然分枝杆菌	8	3.75
鸟分枝杆菌	5	2.35
戈登分枝杆菌	3	1.41
龟分枝杆菌	3	1.41
瘰疬分枝杆菌	2	0.94
M.arupense	1	0.47
M.peregrinum	1	0.47
M.phocaicum	1	0.47
M.sinense	1	0.47
M.vanbaalenii	1	0.47
M.dioxanotrophicus	1	0.47
总计	213	100.00